Neuro Flashcards
What are the diagnosis criteria for pseudotumor cerebrii
features of increased ICP, no evidence of other causes
no findings on CSF except increased pressure
What are the treatment modalities available for pseudotumor cerebrii and how does it work?
weight loss. acetazolamide, inhibits choroid plexus carbonic anhydrase. short term corticosteroids or serum LPs can can serve as bridging therapy while awaiting surgery
Describe the presentation of cluster headaches
explosive unilateral headaches, associated with ipsilateral lacrimation, rhinorrhea, red eye, stuffy nose
What are the signs of a spinal epidural abscess?
fever, severe focal spinal pain, neurologic deficits
What is the treatment for spinal epidural abscess?
MRI, antibiotics, and then urgent surgical evacuation
What are the reversible causes of demenita?
hypothyroidism, B12, thiamine deficiency, hypocalcemia
What medications exist for dementia? Are they effective?
cholinesterase inhibitors - used for moderate dementia
Where is the most common site of ulnar nerve entrapment?
elbow
Pure sensory stroke. Where is the lesion?
VPL nucleus
What is pseudodementia?
dementia with onset of depression that is reversible with SSRIs
How are acute exacerbation of MS treated?
corticosteroids
Explain the common causes of myopathy
connective tissue diseases (polymyositis, vasculitis)
endocrine (hypothryoidism, cushings, electrolytes (low K+, Ca+
drugs (corticosteroids, statins, alcohol, cocaine, heroin)
misc (infections, trauma, hyperthermia)
Explain the presentation of polymyositis
proximal muscle weakness, Raynaud’s, interstitial lung disease,
What is the first test that should be done in a patient with elevated creatinine kinase and myopathy?
TSH (must rule out hypothyroidism)
How do you distinguish pseudodementia from Alzheimer’s?
Pseudodementia patients are concerned about their memory loss
What is the best indicator of dementia in a patient?
impaired daily functioning
Describe cauda equina syndrome
bladder atony with incontinence, bilateral sciatica, saddle anesthesia, loss of anal sphincter tone
What are the neuro findings of Wernicke’s syndrome?
altered mental status, nystagmus, conjugate gaze palsy
What are the findings of cobalamin deficiency?
impaired vibratory and position sense and gait abnormalities
A patient presents with periodic confusion, insomnia, frequent falls, decreased alertness and visual hallucinations. What are the findings on pathology?
lewy bodies (lewy body dementia)
What are the pathologic findings of Alzheimer’s dementia?
neurofibrillary tangles and senile plaques.
What are the neurological findings of NPH?
demenita, abnormal gait, urinary incontinence, broad based gait, shuffling, bradykinesis
Describe typical presentation of Huntingtons
Autosomal dominant, presents with chorea, personality changes, demenita
Describe the features of parkinsons
mask like facial expression, bradykinesia, resting tremor, rigidity, festinating gait, anosmia, REM sleep disorder
Describe tabes dorsalis
loss of propioception - patient walks with feet wide apart, feet lifted higher than usual, make a slapping sound when in contact with floor
Describe essential tremor and its treatment
persistent progressive tremor that begins in adulthood, improves with alcohol, worsens with activity
primidone and beta blockers are good treatment
What are the manifestations of a cerebellar hemorrhage?
ataxia, vertigo, vomiting, poss. 6th nerve palsy, conjugate deviation, blepharospasm
What meds can be used to treat a Parkinsonian tremor?
anticholinergic (trihexyphenidyl)
selegiline (MAO inhibitor)
bromocriptine (dopamine agonist)
What are the causes of foot drop?
peripheral neuropathy, trauma, L5 root radiculopathy, congenital (charcot marie tooth)
How can central nervous system lesions be distinguished from peripheral nerve facial lesions/
central nerve - contralateral lower facial weakness sparing the forehead
Progressive ascending paralysis with no autonomic dysfunction, no fever or sensory abnormalities is most likely…
a tick borne illness
Describe the presentation of botulism
descending paralysis with early cranial nerve involvement
A patient presents with headache, bilateral face pain, low grade fever, bilateral periorbital fever. This is…
cavernous sinus thrombosis
Distinguish between Cauda equina syndrome and conus medullaris syndrome. What is the treatment?
cauda equina - bilateral severe radicular pain, asymmetric motor weakness, hyporeflexia, late onset bowel/bladder, saddle anesthesia
conus medullaris - sudden onset back pain, symmetric motor weakness, hyperreflexia, perineal anesthesia
Emergency MRI, glucocorticoids
What is the “clasp knife” phenomenon and when does it occur?
velocity dependent resistance in pyramidal tract disease
What is the drug of choice for trigeminal neuralgia?
carbamazepine
An HIV patient presents with non-enhancing lesions of the brain with hemiparesis and disturbances in vision..This is…
PML
An HIV patient presents with enhancing lesions of the brain. What is this and where is it, probably?
toxoplasmosis in the basal ganglia
An HIV patient presents with EBV DNA in CSF. What will be the findings on MRI?
primary CNS lymphoma, solitary, weakly enhancing, periventricular
A patient presents with contralateral hemianesthesia and dysesthesia. Where is the lesion?
thalamus
Pure motor hemiparesis. Where is the lesion?
lacunar stroke in posterior limb of internal capsule
Dysarthric clumsy hand syndrome. Where is the lesion?
lacunar stroke in basis pontis
Ataxic hemiparesis
lacunar stroke in anterior limb of internal capsule
What drug is approved for ALS patients?
Riluzole (glutamate inhibitor) may promote survival
What findings are typical of Huntingtons disease on CT?
atrophy of the caudate nucleus
What are the CT findings in Pick’s disease (frontotemporal dementia)? How does it present?
frontotemporal atrophy - presents with personality changes and dementia
How is brain death defined? (what will and will not be present?) e.g. reflexes, autonomic, spontaneous breathing
no cortical or brain stem findings, no spontaneous breathing, no pupillary reflex, no response of HR to atropine due to loss of vagal, may have deep tendon reflexes
What are the early and late findings of alzheimers?
early - visuospatial defects, cognitive impairments, language difficulties
late - neuropsychiatric, lack of insight, urinary incontinence
An older patient presents wtih decreased conciousness, headaches, cognitive deficits, memory deficits in the setting of frequent falls. This is…
chronic subdural hematoma
A patient presents with abrupt stepwise deterioration of memory and especially deficits in executive function. This is..
multifocal stroke
What are the findings of AIDs dementia complex?
cortical and subcortical atrophy
What are the best treatment options for RLS?
dopamine agonists
What are the characteristic CSF findings for bacterial meningitis?
increased PMNs, decreased glucose, gram stain with organisms
A non-immunocompromised patient presents headaches/fevers. CSF shows elevated pressure, lymphocytes, elevated protein, normal glucose. What is this?
herpes encephalitis
What studies are indicated for a patient who presents with amaurosis fugax?
neck duplex - cholesterol emboli develop in the carotids
What findings in CSF might indicate multiple sclerosis?
oligoclonal bands
What test should be done to evaluate for SAH?
Non contrast CT (contrast might confuse vessels with bleed)
What are some of the ways to treat delirium in the hospital?
restore day light cycles, discontinue urinary catheters, discontinue unecessary meds, discontinue fluoroquilonoloes, take off an benzos
What are the most common causes of vertigo? Distinguish between them
Meniere’s disease, BPPV (resolves on own), vestibular neuritis (single episode after a virus), migranous vertigo (associated with migraines), stroke (acute onset)
Describe meniere’s disease
recurrent vertigo preceded by ear fullness/pain, unilateral hearing loss
What is the cause of BPPV? What maneuver can be used to diagnose it?
brief episodes of vertigo caused by crystalline deposits in the semicircular canals. diagnosed with Dix Hallpike maneuver (rapidly have patient sit back, see nystagmus)
What maneuver can be used to relieve the symptoms of BPPV?
cannith repositioning (Epley maneuver)
How do you distinguish frontotemporal dementia from Alzheimer’s disease?
frontotemporal dementia - earlier onset, more personality change and loss of restraint than memory loss. Often progression to muteness
What are the CT changes observed in alzheimer’s?
diffuse cortical and subcortical atrophy greater in the temporal and parietal lobes
A patient presents in a coma with right sided hyperreflexia and left conjugate gaze deviation. This is likely…
a lesion of the left cerebral hemisphere - left basal ganglia hemorrhage
A patient presents in a coma with neck stiffness, facial weakness and no hemiparesis. This is likely…
cerebellar hemorrhage
A patient presents in a coma with hemiparesis, upgaze palsy, and eyes deviated towards the hemiparesis. this is …
thalamic hemorrhage
A patient presents with deep coma and paralysis as well as pinpoint reactive pupils. This is likely…
a pontine hemorrhage
What is the Rinne and weber test, and what do abnormal findings on these tests indicate?
Rinne test - greater bone conduction than air conduction. indicates conductive hearing loss
Weber test - with conductive hearing loss, lateralizes to affected ear bc inner ear can pick up sounds
A young woman in her 20s presents with conductive hearing loss. This is likely…
otosclerosis
Ototoxic antibiotics, acoustic neuromas, presbycusis are examples of…
sensineural hearing loss
A patient presents with contralateral somatosensory and motor weakness (especially face, arm and leg), hemineglect, conjugate eye deviation towards the infarct. This is..
middle cerebral artery infarct
A patient presents with contralateral somatosensory and motor weakness in the lower extremities and emotional disturbances. This is..
anterior cerebral artery infarction
What are Uhthoff’s and Lhermitte’s signs?
Uhtoff - worsening MS symptoms with heat
Lhermitte - electric shock sensation with flexion of neck
How is MS diagnosed?
at least 2 distinctive episodes of nervous system dysfunction with T2 weighted imaging showing lesions
What is the treatment for toxoplasmosis?
sulfadiazine and pyrimethamine
What is the treatment for neurocystercosis?
albendazole
A patient presents with tinnitus and hearing loss and cafe au lait spots. This is… (and how is it diagnosed)
neurofibramatosis II, causing an acoustic neuroma - diagnose with MRI with gadolinium
A patient presents with hypertrophy of the SCM muscle and involuntarily turns and fixes head on the right hand side. This is..
torticollis
What is akathisia?
feeling of restlessness
What is athetosis?
slow writhing movements of hands seen in Huntington’s disease
What is hemiballismus?
unilateral violent arm flinging
A patient recently had a pelvic fracture and can’t get an erection. This is likely…
neurogenic
A patient presents with a 4 month history of headaches worsened by bending, coughing, and sneezing. It is associated with nausea and vomiting as well as a personality change. CT shows butterfly shape with central necrosis and serpiginous enhancement. This is..
glioblastoma multiforme
How is parkinson’s disease diagnosed?
physical exam
A patient presents with frequent falls, numbness in the toes and lower extremity weakness after an upper respiratory tract infection. What is the best mechanism of diagnosis?
this is guillan barre syndrome - diagnosed with LP that shows elevated protein with normal white count
A patient presents with pulsatile headaches that worsen when lying flat and changes in vision. LP shows elevated opening pressure and nothing else. what medications can cause this?
this is pseudotumor cerebrii - growth hormone, tetracyclines, vit A,
What are the risks of the typical antipsychotic fluphenazine?
can cause hypothermia,
A patient comes in with arreflexic weakness of the upper extremities and anesthesia in a cape” distribution. This is
syringomyelia (central cord cavitation)
A patient presents with spasticity, hyperreflexia and fasciculations. This is…
ALS - upper and lower motor signs
What are common side effects of metoclopramide?
agitation, loose stools, tardive dyskinesia, dystonic reactions, Parkinsons
A 78 year old patient with alzheimer’s presents with sudden subarrachnoid hemorrhage. This could be due too..
amyloid angiopathy - second most common cause of ICH, caused by deposition in vessels
Hypertension causing hemorrhage typically occurs where?
intracerebral
The typical presentation of venous sinus thrombosis…
progressively worsening headache over days - usually occurs intracerebral
A patient presents with bitemporal vision loss and sexual dysfunction. This is probably..
craniopharyngioma - derived from remnants of Rathke’s pouch
A patient presents with double vision, jaw cramps while eating steak and changes in her voice over time. The first test should be…
CT of chest for thymoma
A patient presents with weakness of right upper extrimity lower extremity (with spasticity) and ataxia as well as unilateral and visual loss. You might note internuclear opthalmoplegia. What is the next step? (what is treatment? )
MRI - check for MS. Tx with steroids
A lesion of the optic radiation causes what vision disturbance?
contralateral hemianopia
A patient presents with vertical dipolpia and extorsion of the eye. This is..
lesion of trochlear nerve
A patient presetns with convergent strabismus and horizontal diplopia. This is..
lesion of abducens nerve
Carotid artery thrombosis most commonly affects what part of the brain?
MCA territory - contralateral hemiparesis and hemianesthesia
Hemi neglect of the left world probably results from a lesion in..
right parietal lobe
A tremor that worsens when the patient is distrcted, worsens at rest and has a “pill rolling quality” is likely..
parkinsons
A low amplitude tremor that worsens with caffeine and is worse with steady posture holding is…
physiologic
What is a possible complication of pseudotumor cerebrii?
blindness
What are the best options for tx of acute migraines?
IV antiemetics (prochlorperazine, e.g.), NSAIDs, triptans
What are the triggers for meniere’s disease?
alcohol, caffeine, foods high in salt
